Adult idiopathic hypertrophic pyloric stenosis.

Idiopathic hypertrophic pyloric stenosis (IHPS) is a predominantly infantile disease. The adult type of IHPS is extremely rare but it has been well recognized since the 19(th) century. We report a case of a 47-year-old male patient who presented with postprandial nausea and vomiting. He underwent upper gastrointestinal endoscopy, and gastric outlet obstruction was discovered. The upper gastrointestinal barium study showed a distended stomach with delayed gastric emptying due to pyloric stenosis. The abdominal computed tomography revealed thickening of the distal stomach. Since gastric malignancy could not be excluded, he underwent antrectomy with Billroth I anastomosis. The pathology revealed no malignancy but showed hypertrophy and hyperplasia of the inner circular muscle of the pylorus, which was compatible with IHPS. We reported the case to remind young physicians of this rare disease.

Severe, recurrent lupus enteritis as the initial and only presentation of systemic lupus erythematosus in a middle-aged woman.

We describe a previously unreported condition of severe, recurrent lupus enteritis accompanied with severe hypocomplementemia as the initial and only presentation of systemic lupus erythematosus. Systemic lupus erythematosus should be suspected in any patient with computed tomography findings of enteral vasculitis or ischemic enteritis, even without lupus-related symptoms or signs; C3/C4 levels may be helpful in the differential diagnosis. If the symptoms do not improve after medical treatment, such as using steroid or cyclophosphamide pulse therapy, or necrosis and perforation of the intestines are highly suspected, surgical intervention should be considered.